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AF | PDBR | CY2014 | PD-2014-02106
Original file (PD-2014-02106.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-02106
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150313
SEPARATION DATE: 20080917


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (A-10, F-16 and U2 Avionics Systems Journeyman) medically separated for right inguinal pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB). The condition characterized as “groin pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “right inguinal pain, status-post exploratory laparoscopy” as unfitting, rated 10%, c iting application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20080702
 VA* - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Inguinal Pain, Status-Post Exploratory Laparoscopy 8730 10% Post-Operative Right Inguinal Herniorrhaphy 7338 0% 20090223
Healed Right Inguinal Herniorrhaphy Scar (Also Claimed as Abdominal Condition with Pain In The Lower Belly Or
Lower Right Quadrant And Neuralgia)		 7804 10% 20090223
Other x 0 (Not In Scope)
 Other x 6
RATING: 10%
 RATING: 60%
* Derived from VA Rating Decision (VA RD ) dated 20 090604 (most proximate to date of separation [ DOS ] ) .

ANALYSIS SUMMARY:

Right Inguinal Pain Condition. The treatment record reflected that the CI had a right-sided inguinal hernia repair done in 2005 with a return of painful symptoms in 2006. In March 2007, he again exacerbated his symptoms while moving furniture. Having no radiographic evidence of re-herniation, his painful symptoms persisted to include positive physical exam findings of a repeat occurrence. On 30 November 2007, the CI underwent exploratory surgery of his right inguinal area that revealed normal/intact anatomy. No hernia was found. Post-operative diagnoses included inguinal neuralgia, and bilateral hydro and varicoceles in the scrotum. His condition worsened to the point of limiting his duty performance and an MEB was initiated.

At the MEB narrative summary examination on 7 May 2008; 4 months prior to separation, the CI’s chronological history was listed with continuing right-sided inguinal pain. The physical examination (PE) was brief without specific inguinal and or scrotal notations. The diagnosis was listed as “chronic groin pain” and the examiner noted an inability of the CI to function in his primary AFS.

At the VA Compensation and Pension examination on 23 February 2009; 5 months after separation, the CI reported, “…constant pain at surgical site” and “Something inside catches that freezes me until it calms down. I keep moving it last about 30 seconds until it passes.” The examiner listed, “The [CI] does not experience any functional impairment from this condition.” A detailed clinical PE was normal excepting a left-sided varicocele. The VA’s diagnosis was post-operative right inguinal repair, and left varicocele. His occupation was a student.

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition, whereas the PEB rated 10% under 8730 (neuralgia; ilio-inguinal nerve) IAW §4.124a Schedule of Ratings, Neurologic Conditions and the VA rated 0% under 7338 (Hernia; inguinal) IAW §4.114 Schedule of Ratings, Digestive System. Absent actual herniation as discovered by surgical exploration, code 7338 is non-applicable in this case and Board members agreed that a neurological coding approach was appropriate. In this case, the persistent symptomatology coupled with correlated nerve identification is specifically supported by VASRD code 8730. The VASRD §4.124a descriptive rating criteria for ‘neuralgia’ is excerpted below:

Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis.

Board members acknowledged that the maximum rating level available for this specific code is 10% “complete paralysis.” Based upon the above, a logical deduction could be made that if measured in context of “incomplete paralysis”…such impairment would be less than 10%, or at least not greater than 10%. Therefore, the maximum available under the nerve code is of no additional benefit to the CI’s current PEB rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s 10% adjudication for the right groin pain.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the right inguinal pain condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140506, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review





 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762


Dear XXXXXXXXXXXXXXXXXXXX :

 Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02106 .
         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

 Sincerely,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR

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